Helping Patients Choose Their Breast Reconstruction Option

Mazen Bedri, MD, is Director of Aesthetic & Reconstructive Breast Surgery at Virginia Hospital Center and part of the Reinsch Pierce Family Center for Breast Health. A graduate of Johns Hopkins University School of Medicine, he is currently an Assistant Professor in Plastic Surgery there. He completed his fellowship in Plastic and Reconstructive Surgery at Johns Hopkins Hospital. He then completed a fellowship in Breast Reconstruction and Aesthetic Surgery at Mercy Medical Center, where he gained additional expertise in microsurgical breast reconstruction and cosmetic procedures.

The options for and timing of breast reconstruction can be confusing for many patients as they deal with cancer diagnosis and treatment. Questions they pose may include: Implant or autologous tissue? How are mastectomy and reconstruction best coordinated? What happens when radiation is involved?

For this reason, plastic and reconstructive surgeon Mazen Bedri, MD, says coordinating care with colleagues within the Reinsch Pierce Family Center for Breast Health, provides a tangible benefit to patients. “This model offers patients integrated and seamless care under one roof,” he says.

Implant or Autologous Tissue?

A principal decision Dr. Bedri helps women make is which reconstructive option is best for them. He discusses a variety of approaches, including implant-based and autologous options, to help guide patients to a decision best-suited to their circumstances and goals (see Box). Factors include individual medical considerations, length of recovery, possible future procedures, aesthetics, and perceptions about the safety of each reconstructive option.

In autologous reconstruction, the patient’s tissue from the lower abdomen (similar to a tummy-tuck) or, less commonly, the gluteal region or inner thigh is used to attain very natural results. Autologous reconstruction is often preferred in settings of radiation treatment. Recent techniques allow surgeons to use skin and fat, while leaving muscle in place, which Dr. Bedri says minimizes abdominal wall bulges and hernias, as well as back pain associated with more traditional techniques.

Implants offer a safe alternative to patients who may not have enough tissue for autologous reconstruction or who desire shorter recovery.

Sequencing Breast Reconstruction

Dr. Bedri works closely with breast surgeons to offer reconstruction concurrently with mastectomy. Over 95% of patients undergoing mastectomy at the Reinsch Pierce Family Center for Breast Health undergo immediate reconstruction, compared to less than 40% nationally. Factors such as post-mastectomy radiation may necessitate staged reconstruction with a tissue expander, with later plans for definitive reconstruction.

Reconstruction as part of breast cancer treatment is covered by most group insurance plans since passage of the Women’s Health and Cancer Rights Act of 1998. The law covers all stages of reconstruction, as well as procedures to achieve symmetry on the unaffected breast.

Dr. Bedri emphasizes it is “almost never too late” for patients who desire delayed reconstruction or revisions of prior reconstructions. Women who chose not to have reconstruction in the past or are not satisfied with results of prior surgery may be able to benefit from reconstructive options.

On the Horizon

Breast reconstruction continues to advance. New donor-site areas continue to be described as possible options for autologous reconstruction, while ongoing research furthers the field’s understanding of how fat grafting can be safely used. And the recent availability of anatomic-shaped implants offers patients another post-mastectomy reconstructive option.

—Mazen Bedri, MD

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KEEP IN MIND

Reconstruction, including symmetry procedures on the remaining breast, is covered by most group insurance plans.

The plastic surgeon will help the patient select the best reconstruction option to fit her individual circumstances.

Surgery can, in most cases, be performed on women well after a mastectomy or on women not satisfied with their original reconstruction.

Helping Women Select Their Preferred Option

Dr. Bedri said educating women so they, not he, decide what type of breast reconstruction to undergo is an important aspect of treatment. “ I guide women so they make the best decision for their unique situation, ” he said, and is a strong proponent of offering all available options. While some medical issues direct the decision towards autologous versus impact-based reconstruction, nuances often come into play, such as length of time a woman can take leave from a job or her family situation.